Schizophrenia pinpointed as a key factor in heat deaths

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The mental illness tripled the risk of death during a searing 2021 heat wave, researchers find.

On 25 June 2021, as a blanket of hot air descended on the Pacific Northwest, British Columbia’s provincial government issued a news release warning about the approaching heat wave’s dangers. The announcement drew attention to the elderly, children, people working or exercising outdoors, pets, and “people with emotional or mental health issues whose judgment may be impaired.”

Even so, more than 600 people died from the heat in British Columbia, as temperatures topped 40°C for days, shattering records in a region better known for temperatures usually half as high.

Now, new research has zeroed in on one of the hardest hit groups: people with schizophrenia. Epidemiologists combing through provincial health records found that, overall, those with mental health conditions seemed to have an elevated risk of a heat-related death. That was most severe for people with schizophrenia—a 200% increase compared with typical summers. “Those are really large numbers and … alarming,” says Peter Crank, a geographer at Oklahoma State University, Stillwater. 

“We didn’t protect them,” laments Sarah Henderson, an environmental epidemiologist at the British Columbia Centre for Disease Control who oversaw the research, published on 15 March in the journal GeoHealth. “These results show that people with schizophrenia need extra protection, extra support, and extra care.”

Earlier research had shown schizophrenia can make people more vulnerable to heat. Crank, for instance, recently reported a link between higher temperatures and hospitalization of people with schizophrenia in Phoenix. But the connection “just hasn’t made it to the mainstream,” Henderson says.

Overall, more than 8% of the people who died during the hot week had a history of schizophrenia, compared with 2.7% in the same week during a typical year. The results were even more striking for a subset of the total deaths—the 280 that the provincial coroner’s service certified as being heat related. Thirty-seven people who died—more than 13%—had schizophrenia. 

The death toll isn’t a surprise to George Keepers, a psychiatrist and schizophrenia specialist at Oregon Health and Science University who wasn’t involved in the study. “There’s a whole host of things that people with this very unfortunate illness are vulnerable to,” Keepers says. 

For instance, schizophrenia can affect the brain’s hypothalamus, which helps regulate temperature through sweating and shivering. Some antipsychotic medications can raise body temperature, which can have deadly effects when coupled with extreme heat. The disease affects people’s ability to make reasoned decisions or sense when they are ill. People with schizophrenia tend to have other conditions tied to heat-related illness, such as diabetes. Finally, schizophrenia is associated with isolation and homelessness, which puts people at risk when temperatures rise. 

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